An Aspirin a Day? Only If You Have Had a Heart Attack

FDA issues recommendation against preventative low doses


If you never have had any cardiovascular problems, the Food and Drug Administration (FDA) says you should not take aspirin to avoid a heart attack or stroke.

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In a recommendation issued this week, the FDA says scientists have not proven aspirin therapy has any benefit for people without cardiovascular problems. This group includes those with risk factors such as a family history of heart disease.

At the same time, people taking aspirin every day face serious risks. These risks include developing dangerous bleeding into the stomach or brain.

What if I have an existing heart condition?

If you have heart disease, such as a prior heart attack, bypass surgery or stents, everyone agrees that you should be taking a daily baby aspirin (81 mg) unless your doctor determines that you have a very high bleeding risk. For people without previous heart disease, aspirin is generally not recommended because bleeding in the brain or stomach can occur with daily aspirin use—even if you are taking coated aspirin.

For individual patients, your doctor will be able to calculate your risks and benefits from taking aspirin. Every heart condition is different and every patient’s situation is unique. Your doctor will need to know your medical history and weigh the risks.

Only for a select few

When you have a heart attack, it’s because one of the coronary arteries, which provide blood to the heart, has developed a clot. The clot obstructs the flow of blood and oxygen to the heart.

Aspirin thins the blood, which makes it less likely to clot. The logic is that taking an aspirin a day helps prevent heart attacks.

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Clinical data since the 1990s does show that a daily low dose of aspirin can help prevent a re-occurrence for people who have had a heart attackstroke or disease of the heart’s blood vessels, the FDA says.

But only a select few patients benefit from aspirin therapy – even among those who have had cardiovascular problems.

The patient who would benefit from aspirin therapy is someone who has every risk factor: high blood pressure, high cholesterol, strong family history, diabetes, smoking. Among patients with all of these risk factors, some of them we will treat with aspirin. But it’s not very many.

Bleeding common

Internal bleeding, especially in the stomach, is quite common with daily aspirin use.

So if you have a low risk of a heart attack, the bleeding risk may overwhelm any potential benefit of aspirin.

The recommendation came on the heels of the FDA denying a request from Bayer. The drug manufacturer asked to change its aspirin packaging to say consumers could use aspirin as a prevention measure, even if they have not had a heart attack, stroke or cardiovascular problems.

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You should stop taking aspirin if you’re taking it without a doctor’s guidance to prevent cardiovascular problems and have no history of heart disease or heart attack.

Don’t self-medicate

Above all, talk with your doctor.

Frankly, self-medication is almost never a good idea, whether it’s aspirin or anything else.

The FDA recommendation applies to doses ranging from 81 milligrams in a low-dose tablet to the 325 milligrams in a regular-strength tablet.

For patients with a history of cardiovascular problems, the FDA says your doctor should tell you the aspirin dose and frequency that will provide the greatest benefit with the least side effects.

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